Aims and Objectives: To find out if ischemia modified albumin can be a novel marker in ischemic heart disease. Materials and methods: Retrospective chart-review of chest pain patients who were evaluated in the emergency departments in 2006 and 2007. Results: Total of 400 patients presented with chest pain and subsequently were evaluated in the Emergency department at two major emergency departments associated with the teaching hospital associated Mercy Catholic Medical Center; few patients were excluded due to unavailability of complete data and follow-up visit in next six months. Thus, finally 351 patients met criteria for final analysis. Primary endpoints included the cardiac events and secondary outcomes were course in the hospital, days of hospitalization, interventions done in the hospital, disposition from the hospital, and readmission within next six months. Sensitivity and specificity of ischemia modified albumin (IMA) test was 80% and 50% respectively and positive predictive value and negative predictive values were 17% and 88% respectively. There were no further differences in cardiac events or interventions in higher ischemia modified albumin (IMA) group as compared to troponin (cTnT) (p=0.5). People with higher ischemia modified albumin (IMA) showed longer hospitalization days (p=0.025), needing nursing home or skilled nursing facility on discharge due to high discharge needs (p=0.0001) and had more readmissions as compared to troponin (p=0.02). However, Higher ischemia modified albumin (IMA) did not predict more cardiovascular events during hospital stay, rather troponin (cTnT) test predicted arrhythmia more than ischemia modified albumin (IMA) test (p=0.0001). Conclusion: Ischemia-modified albumin may be utilized as a novel marker of ischemia to rule out acute coronary syndrome along with troponin and electrocardiogram in the emergency departments. This test may also have short and long-term prognostic significances and may even be used as a surrogate marker in stroke, sepsis and thrombo-embolic diseases once these people need admission to the hospital.